Health Services: Rural Areas

Motion made, and Question proposed, That this House do now adjourn.—(Gerald Jones.)

Let me get my specs on properly, Madam Deputy Speaker. They have a wonky leg that sticks out sideways.

I must say at the outset that I have heard some excellent maiden speeches today. It is a bit worrying to hear such good maiden speeches, because it makes one feel somewhat mundane in comparison. Let me also welcome the Minister to her place: it is a pleasure to see her sitting opposite me.

This Adjournment debate is the first of the new Parliament, and I am grateful to the Speaker for granting it. It concerns a topic that is important not only to my constituents in the highlands, but to constituents in every rural area in the country. I thank the Minister for her attendance, and look forward to hearing what she has to say. I hope that the debate sets the tone for how a Government and an Opposition can work together to meet the needs of every citizen of the United Kingdom, no matter where they live.

I recently had the great honour of being re-elected to represent Caithness, Sutherland and Easter Ross, which is now the largest constituency in the United Kingdom. It measures a staggering 11,798 sq km, more than half the size of Wales. We are here tonight to discuss the adequacy of healthcare services in rural areas, and for fear of being predictable I am afraid to say that the health services in the highlands are not even faintly adequate. I recognise, of course, that health is devolved, but 17 years of centralisation have wreaked havoc on my part of the world. Health services have been stripped back and gutted, leaving my constituents with access to far too few local services.

Let me begin with general practices. In Scotland, we have seen changes in vaccination services because, in an effort to reduce GPs’ workload, GP contract Scotland removed their vaccination capabilities. That is of huge concern to crofters in my constituency who might cut themselves on a piece of barbed wire and need a tetanus vaccination as quickly as possible. The same goes for anyone in need of shingles, flu, covid or travel vaccines. They must travel a staggering 70 miles or more to the nearest A&E, where they will face further waits owing to backlogs resulting from heavy workloads.

I want to keep the tradition alive, Madam Deputy Speaker. This is my first intervention during an Adjournment debate in the new Parliament.

I commend the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising an issue that is very important to me and to my constituency. I also congratulate him on his excellent victory in the polls: he has done exceptionally well. I hail from a rural constituency where my own doctor has to service a huge number of people, and the inadequacy of help for rural constituents is abundantly clear to me. Does the hon. Member not agree that the current postcode lottery must end, and that access to GPs, physiotherapists, nutritionists and mental health services for farming and other rural communities must be at least on a par with those in cities and large towns? Why should those in rural communities be second-class citizens in their own country?

The hon. Member makes his point with his customary charm. It is no wonder that he is so well liked in this place, because he always speaks for his constituents.

I have talked about the delays in vaccinations, which also applies to the lifesaving vaccinations that babies must have. The Scottish Government take a one-size-fits-all approach that, frankly, does not work in remote rural areas such as mine. The retention and recruitment of GPs and other healthcare workers is crucial, but poor wages and terms and conditions, and a lack of proper travel reimbursement, all lead to a general impression that the game is simply not worth the candle. That is why we are missing key workers and doctors, and why we are paying through the nose for locum and temporary staff. Madam Deputy Speaker, can you believe that NHS Highland has spent £21 million on locum staffing in the past year? That is almost 3% of its entire budget—an eye-watering sum. Could that money not have been spent much better, for example on care homes, hospitals or pain clinics that have been forced to close?

I apologise for coming a bit late to this debate. Primary care is asked to do more in rural areas than in urban settings, piling pressure on GPs, pharmacists and dentists, yet they struggle to recruit staff, as my hon. Friend said. A dental practice in Street, in my constituency, has been without an NHS dentist on its books for 18 months, despite its best efforts. Does my hon. Friend agree that we must explore ways in which we can incentivise healthcare professionals to practise in rural areas?

I absolutely endorse that. I am glad that I said in my opening remarks that my experience in a very remote part of Scotland applies to other parts of the United Kingdom. What we have just heard proves that this is the case.

NHS Scotland has halted all new builds and repairs to health centres across the entire country, which is another problem for healthcare. I have said already how big my constituency is. Just by commuting or doing house visits, healthcare staff will rack up 3,500 miles easily, because the distances are so great. At that point, their reimbursement per mile is more than halved, which does not encourage people to get involved. It is, in fact, discrimination against healthcare professionals who live in rural communities. Training is overwhelmingly based in urban areas, and there is very little incentive to get people to come and work in rural areas. Other factors, such as a lack of housing and job opportunities, feed into this problem.

There is another issue I want to raise: the lack of women’s health provision, which is pretty severe. In my maiden speech in 2017 I spoke about the need to restore maternity services to Caithness. Seven years later, that is more important than ever. Caithness general hospital used to have a consultant-led maternity service, which meant that expectant mothers could have their babies locally in the far north of Scotland. It was downgraded when I was my constituency’s Member of the Scottish Parliament. At that time, I had more influence and I got it restored. Since then, however, the maternity services have been downgraded again, and there appears to be no movement from the Scottish Government to reverse that. I wish that some Members from the party of the Scottish Government were present today.

Let me give an example of what this situation means: pregnant mothers have to make a 200-mile round trip in the car to deliver their babies. Imagine a trip like that in the middle of winter, and on rickety-rackety roads in the highlands. In 2019, a pair of twins were born—one was born in Golspie, and the other was born 50 miles away, in Inverness. It is a miracle that those children survived, and that neither a mother nor a child has perished. I have been calling for a safety audit all along, but there has never been one. We know perfectly well what the result would be: the arrangements would be deemed unsafe, if not a breach of human rights.

I am grateful to my hon. Friend for giving way, and I apologise to him for being caught out by the early start of this Adjournment debate. Does he agree that it would be really helpful if the new Government achieved a quick win to raise morale in rural areas where services have been so depleted for so long? This applies in west Cornwall, for example, where we cannot call on services from the north or south or west very easily. In those areas, as in others, we have a dentistry desert and the NHS and care services are experiencing their biggest crisis in their history. What we need, for example, is for the West Cornwall hospital to re-establish the urgent treatment centre overnight. Those kinds of quick wins could achieve the lifting of morale within the service and start moving things forward and upward from where they are at present.

My hon. Friend makes a good point, and I shall touch upon his sentiments in my closing remarks.

As many in the Chamber know—perhaps new Members do not—I myself am a carer: I am a carer for my wife. So I am very happy that my party has put carers at the top of our agenda. My party leader has spoken about being a carer himself. We desperately need reform, and I believe that the carers allowance should be introduced at a higher rate. In a way, I am declaring an interest here, in that I am an unpaid carer, but we have to look at this. I was recently informed of a constituent who was moved from one care home to another one 123 miles away in the highlands. That is a three-and-a-bit-hour journey each way for the loved ones to go and visit that old man. We can see why this is not great for morale.

I am from the highlands. I love my native highlands and I care passionately about where I come from, but I think that we need urgent intervention. This is my ask of the Minister. I recognise the nobility of the intent to address these problems at UK level, and I look forward to working with the Government in these endeavours, but the fact is that there is not the delivery under devolution that there should be. I am sorry that no Scottish National party Members are here. I am a committed devolutionist. I was part of the Scottish Constitutional Convention and my name is on the claim of right for Scotland, yet I find it incredibly disappointing that the outcomes are a lot worse than they were.

When I was in government in the Scottish Parliament, in coalition with the Labour party, we saw progress between 1999 and 2007, when the SNP came in. Now we see that things have gone backwards. This was the main issue on the doorsteps in Scotland, so I hope that the Labour Government can work hard at improving things. I ask them in a cordial way to do everything that can be done to improve the relationship with the Scottish Government, and perhaps encourage the Scottish Government to look at best practice in the rest of the UK and adopt that. I am not talking about hypothecation or about unrolling devolution, but by working together perhaps we can achieve something.

It is a privilege to be the first Minister of this new Labour Government to respond to an Adjournment debate. I am grateful to the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone) for raising this important matter and, indeed, for his kind words.

I hope we can begin this Parliament as we mean to go on, by being candid about the formidable challenges that the NHS faces. As my right hon. Friend the Secretary of State said on his first day in the job, the NHS is broken, and it will be the task of this Government to build a new NHS for the future. That means the NHS in our rural and coastal areas no less than the NHS in our towns and cities. I agree with the hon. Member for Strangford (Jim Shannon) on that point.

Facing these hard truths does not take away from the heroic efforts of the people working in health and care, who have done their utmost in incredibly difficult circumstances. We all owe them, on behalf of our constituents, a debt of unending gratitude.

Instead, we want to focus our attention on what needs to be done, including early action to improve access to primary care, dentistry and dental health services in particular. We await the conclusions of a thorough investigation undertaken by the distinguished surgeon Lord Darzi to properly understand the scale of the problem. The Government will then begin work on an ambitious programme of action—a 10-year plan to put the NHS back on its feet. It is a privilege to be part of a Labour Government who are committed to fixing the NHS and making it fit for the future.

As the hon. Member for Caithness, Sutherland and Easter Ross said, the Department’s responsibility stretches only to the NHS in England. Healthcare is devolved in Scotland, Wales and Northern Ireland, and it will continue to be so.

I congratulate the hon. Gentleman on being first out of the traps to secure this debate on behalf of his constituents. As a committed advocate for his constituents in one of the most rural parts of Scotland, he has a deep understanding of matters affecting rural communities, as we have heard this evening. He also has a deep understanding of care, about which I have often heard him speak in this Chamber. It is good to see him back again doing just that.

The Minister has committed the new Labour Government to address those issues, but will she specifically address the matter of the two coroners’ reports into avoidable excess deaths as a result of very long waits for emergency services in Cornwall? They were never addressed by the previous Conservative Government. The reports were about not just the hours spent waiting—sometimes elderly, frail people were on the floors for 10 or more hours—but the fact that sometimes 20 or more ambulances greeted patients when they arrived at the emergency department. Two coroners’ reports were sent to the then Secretary of State, but there was never an adequate response. I very much hope the new Labour Government will review the failings of the previous Government and address those very serious concerns, which affect many other rural areas.

I am aware of the issues facing the south-west and, when in Opposition, I spoke in the local media about some of the ambulance challenges. I am not aware of those reports, but if the hon. Gentleman writes to me with the details, I will happily look into the issue and get back to him.

We also recognise the additional cost of providing services in rural areas, for example in travel and staff time. That is why the funding formula used by NHS England to allocate funds to integrated care boards includes an element to better reflect needs in some rural, coastal and remote areas.

The NHS faces significant challenges. It needs fundamental reform. The Prime Minister is personally committed to resetting the UK Government’s relationship with devolved Governments in Scotland, Wales and Northern Ireland. I echo the Prime Minister’s words today about our commitment to rural constituencies across the entire country and I hope we can work with hon. Members from across the House, including the hon. Member for Caithness, Sutherland and Easter Ross.

I welcome the Minister’s clear commitment to England, Scotland, Wales and Northern Ireland—and particularly to Northern Ireland. Let me declare an interest: I am a member of the Ulster Farmers Union. I know that the Ulster Farmers Union back home, in conjunction with the NFU here, has been trying to work with the health service and with all those with responsibility in this area on the issue of suicides. Farmers mostly work on their own and suffer from anxiety and depression. They face pressures from finance and pressures from the bureaucracy that exists in farming. I know the Minister is compassionate and understanding—I mean that honestly. When it comes to addressing that issue, does she think that it must be done in conjunction with the farmers unions? Trying to work together to make things better must be a step in the right direction.

As ever, the hon. Gentleman makes a valid point. I shall certainly ask my colleagues in the Department for Environment, Food and Rural Affairs about that. His point is extremely well made. I know his constituency in Northern Ireland very well. Let me say that we are very committed to working with hon. Members across the House to share ideas. The hon. Member for Caithness, Sutherland and Easter Ross has put forward more ideas about how that can happen. I do not promise to implement all of those things, but I will certainly look at them. We want to work very closely across all jurisdictions so that we can make progress for all our constituents to improve the health outcomes across the four nations of the United Kingdom.